Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| Naples, TX | $17.37 | $17.37 – $17.37 | 221 | 1 |
| Whiting, IA | $13.68 | $3.35 – $16.40 | 221 | 2 |
| Jeffersonville, PA | $39.24 | $39.24 – $39.24 | 221 | 1 |
| Douglas, MA | $60.75 | $60.75 – $60.75 | 220 | 1 |
| Lower Burrell, PA | $24.14 | $24.14 – $24.14 | 219 | 1 |
| North Muskegon, MI | $44.39 | $44.39 – $44.39 | 219 | 1 |
| Waco, KY | $34.30 | $34.30 – $34.30 | 218 | 1 |
| Mount Enterprise, TX | $45.65 | $45.65 – $45.65 | 218 | 1 |
| Arnold Afb, TN | $24.95 | $24.95 – $24.95 | 218 | 1 |
| Kingsland, TX | $35.78 | $18.82 – $41.92 | 218 | 2 |
| Joint Base Charleston, SC | $191.09 | $43.13 – $479.00 | 218 | 2 |
| Neeses, SC | $166.05 | $67.30 – $171.80 | 218 | 2 |
| Hartfield, VA | $51.65 | $17.27 – $61.05 | 217 | 3 |
| Stockton, NY | $62.11 | $62.11 – $62.11 | 217 | 1 |
| Jessup, PA | $30.68 | $21.94 – $39.29 | 217 | 3 |
| Lower Kalskag, AK | $0.00 | $0.00 – $0.00 | 217 | 1 |
| Shullsburg, WI | $32.39 | $18.25 – $44.70 | 217 | 2 |
| Lilydale, MN | $59.19 | $59.19 – $59.19 | 216 | 1 |
| Frankston, TX | $22.02 | $22.02 – $22.02 | 216 | 1 |
| Coatesville, IN | $47.23 | $47.23 – $47.23 | 216 | 1 |
| Thorofare, NJ | $111.38 | $44.46 – $115.31 | 216 | 2 |
| Presho, SD | $106.77 | $106.77 – $106.77 | 215 | 1 |
| Whippany, NJ | $62.37 | $7.68 – $69.20 | 215 | 4 |
| Hanna, WY | $29.98 | $29.98 – $29.98 | 214 | 1 |
| Fruitland, NM | $394.52 | $394.52 – $394.52 | 214 | 1 |
| Bridge City, TX | $0.33 | $0.00 – $4.95 | 213 | 3 |
| Berkeley Lake, GA | $60.62 | $60.62 – $60.62 | 213 | 1 |
| Amity Harbor, NY | $89.49 | $89.49 – $89.49 | 213 | 1 |
| Nelson, NE | $34.39 | $34.39 – $34.39 | 213 | 1 |
| Stephenson, MI | $45.20 | $45.20 – $45.20 | 212 | 1 |
| Brooten, MN | $173.47 | $173.47 – $173.47 | 212 | 1 |
| Fort Myer, VA | $60.01 | $60.01 – $60.01 | 212 | 1 |
| State Line, MS | $19.90 | $19.90 – $19.90 | 212 | 1 |
| Ft. Totten, ND | $299.04 | $299.04 – $299.04 | 212 | 1 |
| Manokotak, AK | $62.51 | $58.88 – $71.86 | 211 | 2 |
| Lookout Mountain, GA | $64.90 | $64.90 – $64.90 | 211 | 1 |
| Fertile, MN | $51.37 | $51.33 – $51.41 | 211 | 2 |
| Lanesville, IN | $18.76 | $18.76 – $18.76 | 211 | 1 |
| Meraux, LA | $60.00 | $60.00 – $60.00 | 211 | 1 |
| Battletown, KY | $34.61 | $34.61 – $34.61 | 210 | 1 |
| Rose Hill, KS | $29.85 | $29.85 – $29.85 | 210 | 1 |
| Rochdale, MA | $38.18 | $38.18 – $38.18 | 210 | 1 |
| St Cloud, FL | $54.11 | $54.11 – $54.11 | 210 | 1 |
| Hackett, AR | $41.17 | $41.17 – $41.17 | 209 | 1 |
| Inglis, FL | $61.22 | $61.22 – $61.22 | 209 | 1 |
| Lower Lake, CA | $15.00 | $3.21 – $57.97 | 209 | 2 |
| Pipersville, PA | $51.12 | $0.00 – $63.59 | 209 | 2 |
| Ridgeview, SD | $67.16 | $67.16 – $67.16 | 208 | 1 |
| Scooba, MS | $54.59 | $21.50 – $88.32 | 208 | 2 |
| Boston Heights, OH | $88.43 | $88.43 – $88.43 | 208 | 1 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.